Referral Assessment Form
This is the volunteer application form for volunteers with additional needs at Sutton Community Farm.

All information provided will be used to inform staff to better support the volunteer during their time on the farm. Data will be kept securely and access will only be given to the relevant staff working at the farm.

If you are filling this form in on behalf of the volunteer, please answer as if you were the volunteer, and be sure to include your own details in the referee section of the form.

If you have any questions about anything in this form, please email Sonia (sonia@suttoncommunityfarm.org.uk) or call the Farm Community Phone on 07419 740754

As we are a small organisation with limited staff and volunteer capacity, we cannot always offer sufficient support to individuals with higher support needs. We assess this on a case-by-case basis in consultation with the volunteer, family members and/or carers, and we may ask that the volunteer comes with a support worker or family member, or attends another project that can offer more appropriate support.

It is for this reason that we ask that referrers give us as much information as possible about the person that they are referring, and that they are available to keep in contact with the Community Engagement Coordinator about their referred volunteer.

Please be aware that if we feel we are unable to offer adequate support to an individual we may have to ask that they are supplied with a support worker by the referral body, or we will be unable to continue supporting them at the farm.

If you feel unable to offer this level of follow-up interaction about the person you are referring please provide us with contact details of a family member, support worker, or another relevant individual that we can keep in contact with.

Full name *
Your answer
Home postcode *
Your answer
Contact phone number *
Your answer
Current age *
Your answer
Emergency Contact Details
Contact 1: Full Name & Relationship to You *
Your answer
Contact 1: Phone Number *
Your answer
Contact 2: Full Name & Relationship to You *
Your answer
Contact 2: Phone Number *
Your answer
Health & Disability
If you have any of the following, please tick *
Required
If you have ticked any of the above, please provide more information about the condition and how it might affect you whilst you are on the farm:
Your answer
Is there anything else you would like to tell us about the general state of your health? *
Your answer
We would like to support you as much as possible whilst you are volunteering on the farm. Are there any adjustments we can make to help you participate fully? *
Your answer
Is there any special equipment or aids that you need while you volunteering on the farm? *
Your answer
Referral Details
Are you being referred to volunteer at the farm? *
Who is referring you to volunteer at the farm?
Name of referee *
Your answer
Referee email address *
Your answer
Referee contact phone number *
Your answer
Criminal Convictions
If you have criminal convictions you will need to complete a separate self-disclosure form.

All volunteers are asked to disclose any spent or unspent convictions during their application process. Convictions for fraud, violent offences, sexual offences or offences involving children and vulnerable adults will always raise concerns. All convictions will be reviewed on a case by case basis by the Community Engagement Coordinator and the Farm Business Manager.

Sutton Community Farm is committed to equal opportunities for all volunteer applicants including those with criminal convictions, we are committed to rehabilitation and understand that there are a range of offences, some of which have no bearing on a person’s ability to participate at Sutton Community Farm.

Do you have any criminal convictions?
Other Information
Are you able to travel independently? *
What are your hobbies and interests? *
Your answer
Any other comments:
Your answer
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